Clifton Springs Hospital and Clinic
2 Coulter Road, Clifton Springs, NY · Rochesterregional · · NPI 1366505463
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Wedge rescj/bisctj ovary uni/bi 58920 CPT 58920 | not published | not published | $517.94 – $756.26 | 2 |
| Wedge resect of lung add-on 32506 CPT 32506 | not published | not published | $114.53 – $172.91 | 2 |
| Wedge resect of lung diag 32507 CPT 32507 | not published | not published | $114.53 – $172.68 | 2 |
| Wedge resect of lung initial 32505 CPT 32505 | not published | not published | $726.09 – $1,028.60 | 2 |
| Wedging of cast CPT 29740 | not published | not published | $49.40 – $77.94 | 2 |
| Wedging of clubfoot cast CPT 29750 | not published | not published | $55.12 – $87.01 | 2 |
| Western blot test CPT 84181 | $61.62 | $94.80 | $11.35 – $20.44 | 8 |
| Wet mounts/ w preparations HCPCS Q0111 | not published | not published | $10.10 – $22.25 | 8 |
| Whfo electric custom fitted HCPCS L3904 | not published | not published | $3,292.96 – $3,292.96 | 5 |
| Whfo nontorsion joint prefab HCPCS L3931 | $335.21 | $515.71 | $214.72 – $214.72 | 5 |
| Whfo w/joint(s) custom fab HCPCS L3806 | $774.13 | $1,190.97 | $495.89 – $495.89 | 5 |
| Whole blood for transfusion HCPCS P9010 | $269.42 | $414.49 | $49.45 – $49.45 | 1 |
| Whole blood or red blood cells frozen/deglycerolized/washed leukocytes reduced each unit HCPCS P9054 | not published | not published | $490.75 – $490.75 | 1 |
| Whole blood/red blood cells leukocytes reduced cmv negative each unit HCPCS P9051 | $374.24 | $575.76 | $179.82 – $179.82 | 1 |
| Whole-Body Bone Scan (Nuclear Medicine) CPT 78306 | $812.30 | $1,249.69 | $179.82 – $292.70 | 3 |
| Whole body photography CPT 96904 | not published | not published | $53.96 – $66.81 | 2 |
| Whole mitochondrial genome CPT 81460 | $3,421.81 | $5,264.33 | $779.92 – $1,544.40 | 8 |
| Whole mitochondrial genome CPT 81465 | $2,481.50 | $3,817.70 | $567.22 – $1,123.20 | 8 |
| Whole Skeleton X-ray Survey CPT 77075 | $275.16 | $423.33 | $58.80 – $75.36 | 3 |
| Who nontorsion jnts pre cst HCPCS L3915 | not published | not published | $580.28 – $580.28 | 5 |
| Who nontorsion jnts pre ots HCPCS L3916 | not published | not published | $580.28 – $580.28 | 5 |
| Wilate injection HCPCS J7183 | not published | not published | $1.10 – $1.91 | 6 |
| Wipe adh remover univ ostomy adh/barrier remover HCPCS A4456 | not published | not published | $0.21 – $0.35 | 6 |
| Wnd prep f/n/hf/g addl cm CPT 15005 | not published | not published | $63.68 – $101.81 | 2 |
| Woman's shoe oxford brace HCPCS L3224 | not published | not published | $74.43 – $74.43 | 5 |
| Wound Cleaning and Dead Tissue Removal (up to 20 sq cm) CPT 97597 | $444.52 | $683.87 | $26.10 – $82.91 | 3 |
| Wound closure by adhesive HCPCS G0168 | not published | not published | $11.40 – $17.32 | 2 |
| Woundfix biowound plus xplus HCPCS Q4217 | not published | not published | $103.97 – $1,054.01 | 2 |
| Wound pouch each HCPCS A6154 | not published | not published | $20.49 – $20.49 | 5 |
| Wound therapy negative pressure per session <= 50 sq cm CPT 97607 | $1,107.30 | $1,703.54 | $15.43 – $82.91 | 2 |
| Wound therapy negative pressure per session > 50 sq cm CPT 97608 | $1,107.30 | $1,703.54 | $17.82 – $82.91 | 2 |
| Wound therapy negative pressure per session <= 50 sq cm dme CPT 97605 | $444.52 | $683.87 | $17.90 – $82.91 | 2 |
| Wound therapy negative pressure per session > 50 sq cm dme CPT 97606 | $842.52 | $1,296.18 | $19.61 – $82.91 | 2 |
| Wrist arthroscopy CPT 29840 | not published | not published | $360.00 – $501.86 | 2 |
| Wrist arthroscopy/surgery CPT 29843 | not published | not published | $383.22 – $537.69 | 2 |
| Wrist arthroscopy/surgery CPT 29844 | not published | not published | $385.02 – $555.15 | 2 |
| Wrist arthroscopy/surgery CPT 29845 | not published | not published | $447.20 – $645.64 | 2 |
| Wrist arthroscopy/surgery CPT 29846 | not published | not published | $399.19 – $581.11 | 2 |
| Wrist arthroscopy/surgery CPT 29847 | not published | not published | $421.97 – $598.66 | 2 |
| Wrist/elbow bowden cable mol HCPCS L6580 | not published | not published | $1,918.42 – $1,918.42 | 5 |
| Wrist/elbow bowden cbl dir f HCPCS L6582 | not published | not published | $1,695.08 – $1,695.08 | 5 |
| Wrist endoscopy/surgery CPT 29848 | not published | not published | $397.14 – $569.80 | 2 |
| Wrist X-ray CPT 73110 | $201.75 | $310.38 | $26.16 – $33.33 | 3 |
| Wrist X-ray (2 views, both wrists) CPT 73100 | $201.75 | $310.38 | $20.71 – $26.86 | 3 |
| Wrst mld sck flx hng tri pad HCPCS L6050 | not published | not published | $2,713.15 – $2,713.15 | 5 |
| Xcapsl ctrc rmvl cplx w/ecp CPT 66987 | not published | not published | $1,031.95 – $1,031.95 | 1 |
| Xcapsl ctrc rmvl cplx wo ecp CPT 66982 | not published | not published | $523.95 – $932.35 | 2 |
| Xcapsl ctrc rmvl insj 1+ CPT 66991 | not published | not published | $483.67 – $686.43 | 2 |
| Xcapsl ctrc rmvl w/ecp CPT 66988 | not published | not published | $842.24 – $842.24 | 1 |
| Xcellistem, 1 mg HCPCS A2004 | not published | not published | $13.78 – $15.60 | 2 |
| Xcpsl ctrc rmvl cplx insj 1+ CPT 66989 | not published | not published | $597.71 – $860.56 | 2 |
| Xe133 xenon 10mci HCPCS A9558 | $24.45 | $37.62 | $266.98 – $270.41 | 2 |
| Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/< CPT 14040 | not published | not published | $450.62 – $705.63 | 2 |
| Xfer tis s/a/l 10 sq cm/< CPT 14020 | not published | not published | $415.35 – $632.73 | 2 |
| X-linked intellectual dblt CPT 81470 | not published | not published | $553.88 – $1,096.80 | 8 |
| X-linked intellectual dblt CPT 81471 | not published | not published | $0.01 – $1,096.80 | 8 |
| Xm archive tissue molec anal CPT 88363 | $128.95 | $198.39 | $11.37 – $20.14 | 3 |
| Xpos opn axillary/sbclvn art w/cndt crtn CPT 34716 | not published | not published | $274.23 – $418.34 | 2 |
| Xpos opn fmrl eprst aor uni add-on CPT 34812 | not published | not published | $149.59 – $228.82 | 2 |
| X-ray abdomen >=3 views CPT 74021 | $275.16 | $423.33 | $24.22 – $49.28 | 3 |
| X-ray arthrogram shoulder supervision & interpretation (both sides) CPT 73040 | $732.28 | $1,126.58 | $76.24 – $109.12 | 3 |
| X-ray assay calculus CPT 82370 | not published | not published | $8.34 – $28.17 | 10 |
| X-ray bone length studies CPT 77073 | $280.79 | $431.99 | $22.95 – $33.33 | 3 |
| X-ray bone survey infant CPT 77076 | not published | not published | $59.07 – $76.06 | 3 |
| X-ray consultation CPT 76140 | not published | not published | $8.08 – $36.20 | 2 |
| Xray endovasc thor ao repr CPT 75956 | not published | not published | $710.69 – $710.69 | 1 |
| Xray endovasc thor ao repr CPT 75957 | not published | not published | $607.96 – $607.96 | 1 |
| X-ray exam entire spi 4/5 vw CPT 72083 | not published | not published | $46.36 – $64.57 | 3 |
| X-ray exam entire spi 6/> vw CPT 72084 | $275.16 | $423.33 | $55.97 – $81.09 | 3 |
| X-ray exam of arm infant CPT 73092 | $275.16 | $423.33 | $18.76 – $24.71 | 3 |
| X-ray exam of femur 1 CPT 73551 | not published | not published | $17.40 – $22.19 | 3 |
| X-ray exam of jaw joint CPT 70328 | $201.75 | $310.38 | $20.67 – $26.86 | 3 |
| X-ray exam of jaw joint CPT 70332 | not published | not published | $44.69 – $62.42 | 3 |
| X-ray exam of mastoids CPT 70120 | not published | not published | $24.49 – $30.45 | 3 |
| X-ray exam of middle ear CPT 70134 | not published | not published | $28.09 – $44.46 | 3 |
| X-ray exam of penis CPT 74445 | not published | not published | $54.70 – $166.11 | 2 |
| X-ray exam of perineum CPT 74775 | not published | not published | $67.43 – $166.11 | 2 |
| X-ray exam of salivary gland CPT 70380 | not published | not published | $23.40 – $30.82 | 3 |
| X-ray exam of tear duct CPT 70170 | not published | not published | $43.83 – $217.15 | 2 |
| X-ray exam of teeth CPT 70300 | not published | not published | $7.29 – $8.97 | 3 |
| X-ray exam of teeth CPT 70310 | not published | not published | $27.13 – $32.64 | 3 |
| X-ray exam si joints CPT 72200 | $261.20 | $401.84 | $20.06 – $25.78 | 3 |
| X-ray exam thorac spine4/>vw CPT 72074 | $275.16 | $423.33 | $26.67 – $34.04 | 3 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $201.75 | $310.38 | $19.10 – $24.34 | 3 |
| X-ray fallopian tube CPT 74742 | not published | not published | $52.99 – $135.56 | 2 |
| X-ray head for orthodontia CPT 70350 | not published | not published | $7.84 – $11.08 | 3 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $275.16 | $423.33 | $34.42 – $47.35 | 3 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $275.16 | $423.33 | $37.40 – $48.42 | 3 |
| X-ray joint survey 1 view CPT 77077 | $275.16 | $423.33 | $24.24 – $31.53 | 3 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | not published | not published | $18.76 – $24.71 | 3 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $275.16 | $423.33 | $25.58 – $37.72 | 3 |
| X-ray male genital tract CPT 74440 | not published | not published | $63.72 – $85.05 | 3 |
| X-ray mandible ltd <4 views CPT 70100 | $201.75 | $310.38 | $22.63 – $30.82 | 3 |
| X-ray measurement of pelvis CPT 74710 | not published | not published | $21.67 – $21.67 | 1 |
| X-ray nose to rectum for foreign body child CPT 76010 | not published | not published | $16.57 – $21.84 | 3 |
| X-ray of mammary ducts CPT 77054 | not published | not published | $38.68 – $65.32 | 3 |
| X-ray optic foramina CPT 70190 | not published | not published | $21.48 – $29.02 | 3 |
| Xray place dist ext thor ao CPT 75959 | not published | not published | $354.94 – $354.94 | 1 |
| Xray place prox ext thor ao CPT 75958 | not published | not published | $405.59 – $405.59 | 1 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $732.28 | $1,126.58 | $46.04 – $93.70 | 3 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.